神经外科ICU呼吸机相关性肺部感染病原学分布及耐药性分析

PATIENTS WITH VENTILATOR-ASSOCIATED PNEUMONIA IN NEUROSUERGICAL INTENSIVE CARE UNIT:ANALYSIS OF PATHOGEN DISTRIBUTION AND DRUG RESISTANCE

目的初步分析神经外科ICU(NICU)呼吸机相关性肺部感染(VAP)病原学分布特点及耐药情况,指导临床抗感染治疗。方法回顾性分析统一标准下我院NICU 2005年10月—2014年6月间连续确诊的165例VAP病人下呼吸道分泌物检出病原菌及耐药情况。结果 165例VAP病人共检出病原菌277株,其中革兰阴性杆菌189株,革兰阳性球菌53株,真菌35株。检出前5位病原菌依次为肺炎克雷伯杆菌、金黄色葡萄球菌、铜绿假单胞菌、真菌和鲍氏不动杆菌。鲍氏不动杆菌对头孢哌酮-舒巴坦、亚胺培南及美罗培南的敏感性较高,耐药率分别为25.81%、18.18%和21.21%。铜绿假单胞菌对头孢哌酮-舒巴坦和哌拉西林-他唑巴坦均具有较高的敏感性,耐药率在30%以下。肺炎克雷伯杆菌对哌拉西林-他唑巴坦和头孢哌酮-舒巴坦的敏感率均在80%以上。大肠埃希菌对头孢哌酮-舒巴坦的耐药率为0,对哌拉西林-他唑巴坦的耐药率为7.41%。肺炎克雷伯杆菌及大肠埃希菌产超广谱β-内酰胺酶菌株的检出率分别为58.70%和74.07%。耐甲氧西林金黄色葡萄球菌占检出金黄色葡萄球菌的比例为62.16%。结论 NICU病人VAP主要病原菌为革兰阴性杆菌,其对哌拉西林-他唑巴坦和头孢哌酮-舒巴坦较为敏感,可作为临床经验用药。NICU细菌耐药情况较为严重,需采取相应措施。

Objective To analyze the pathogen distribution and drug resistance of ventilator-associated pneumonia （VAP） in Neurosurgical Intensive Care Unit （NICU） and guide clinical anti-infection therapy. Methods Under the same stan- dards, from October 2005 to June 2014,165 patients with VAP were successively diagnosed in NICU of our hospital, the pathogen- ic bacteria isolated from secretion samples of lower respiratory tract and drug resistance were analyzed retrospectively. Results A total of 277 pathogenic strains were isolated, of which, 189 strains were gram-negative bacilli, 53 strains were gram-positive cocci, and 35 strains were eumycete. The first five detected pathogenic bacteria were Bacillus canalis capsulatus, Staphylococcus aureus, Pseudomonas aeruginosa, eumycete and baumanii. Bacillus canalis capsulatus was sensitive to cefoperazone/sulbactam （25.81 % ）, imipenem （18.18 % ） and Meropenem （ 21.21 % ） ; Pseudomonas aeruginosa showed higher sensitive to cefoperazone/ sulbactam and Piperacillin/tazobactam, with the resistance rate of under 30% ; Bacillus canalis capsulatus was sensitive to Piperacillin/tazobactam and cefoperazone/sulbactam, the sensibility being above 80%. The resistance of Escherichia coli to cefopera- zone/sulbactam was 0, and that to Piperacillin/tazobactam was 7.41%. The detection rates of Bacillus canalis capsulatus and the strains of Bacillus coli that produced extended-spectrum beta lactamase were 58.70% and 74.07%, respectively. Methicillin resist- ant staphylococcus aureus accounted for 62.16% of Staphylococcus aureus detected. Conclusion The main pathogens isolated from patients with ventilator associated pneumonia were Gram-negative bacillius, which were sensitive to Cefoperazone/sulbactam and Piperacillin/tazobactam. The findings can be used for reference in empirical medication therapy. The drug resistance of bacteria in NICU is more serious, corresponding measures should be adopted.